The House voted Thursday to pass President Trump's "big, beautiful bill" after weeks of Republican infighting that repeatedly threatened to tank the GOP-only legislation.

Why it matters: It's a major step toward getting the hulking fiscal package signed into law, though the Senate is likely to make substantial changes that could be difficult for House GOP hardliners to swallow.

• The vote was 215-214.
• Two Republicans — Thomas Massie of Kentucky and Warren Davidson of Ohio — joined Democrats in voting "no," while Andy Harris of Maryland voted present.

The big picture: The bill would extend the 2017 Trump tax cuts and aims to cut $1.5 trillion in federal spending, including through Medicaid work requirements and the repeal of the Inflation Reduction Act tax credits.

• It took considerable wrangling by House Republican leadership to get to this point, with members of the right-wing House Freedom Caucus threatening to oppose it as recently as Wednesday.

State of play: The vote came after a marathon congressional session in which some lawmakers stayed up for days.

• The House Rules Committee met early Wednesday morning to markup the bill only ending late Wednesday night.
• House Democrats gummed up the works with several procedural votes, pushing the vote time back to around 6:30 am ET on Thursday.

Editor's note: This story has been updated with additional reporting.

President Trump warned congressional Republicans on Tuesday not to "f**k around" with Medicaid, a stark pushback to conservative lawmakers demanding steeper cuts to the program in "one big, beautiful bill."

Why it matters: Trump is already floating political retribution for Republican holdouts who don't get in line.

• He also tore into Rep. Thomas Massie (R-Ky.), who has been a firm "no" on the bill throughout the process, blasting him publicly and privately as a "grandstander" and saying he should be "voted out of office."
• Trump also warned the GOP's blue state holdouts not to push too hard on the SALT deduction cap.

What we're hearing: The president stressed to GOP lawmakers that they should limit Medicaid cuts to targeting waste, fraud and abuse.

• Coming out of the meeting, that was a message right-wingers who have pushed for substantial Medicaid cuts echoed: "That's where we should focus our reductions," said Rep. Andy Biggs (R-Ariz.).
• Still, some on the right are still holding out for meaningful enough cuts to offset the deficit impact of the bill's tax cuts. SALT caucus members, too, are digging in.

Zoom in: House Freedom Caucus chair Andy Harris (R-Md.), a key holdout on the bill, said he wants stronger limits on Medicaid provider taxes, which states use to help finance their share of the program's costs.

• "Even the Democrats call the provider tax a scam, and yet the provider tax is mostly intact in the bill in its current form," he said.
• That's in direct conflict with the demands of moderates like Rep. Rob Bresnahan (R-Pa.), who said those limits are "non-starter."

The big picture: Millions of people could lose health coverage if the current reconciliation bill's Medicaid cuts become law.

• "President Trump and Republicans are protecting and preserving Medicaid for the Americans who the program was intended to be a lifeline for: pregnant women, children, disabled individuals, and seniors," White House spokesperson Kush Desai told Axios' Emily Peck.
• That White House list of people who need Medicaid doesn't include the poorer working-age adults without kids who gained coverage under the Affordable Care Act's expansion of Medicaid.

Axios' Peter Sullivan contributed reporting for this story.

Editor's note: This story has been updated with additional reporting.

House Speaker Mike Johnson (R-La.) is staring down a growing rebellion from his centrist wing over cuts to Medicaid in the GOP's "big, beautiful bill."

Why it matters: Moderate and swing-district House Republicans are trying to balance their loyalty to Trump with their increasingly imperiled reelection prospects.

• Many centrists are worried that cutting programs like Medicaid too harshly could inflame the already intense backlash they are facing from constituents over DOGE cuts.

Driving the news: Rep. Don Bacon (R-Neb.) confirmed to Axios that he communicated to the White House he won't support more than $500 billion in cuts to Medicaid.

• "Those are the cuts that don't impact quality of care nor hurt hospitals. A bunch of us will have to be convinced that any other cuts won't hurt patients or hospitals," he said.
• Bacon cited a letter he and 11 other Republicans wrote to Johnson warning against "any reduction in Medicaid coverage for vulnerable populations."
• "I will not vote for any bill that cuts eligible legal people," said Rep. Jeff Van Drew (R-N.J.). "That means our working poor."

The other side: Some members of the right-wing Freedom Caucus pushed back swiftly on Bacon's proposed ceiling, arguing there needs to be sufficient spending reductions to offset tax cuts.

• "These same individuals want to keep all these green energy tax credits and ... raise the SALT cap deduction," said Rep. Eric Burlison (R-Mo.). "You can't have your cake and eat it too."
• "You're not going to get the tax cuts that the American people want ... if you're talking about those kind of low numbers, on actual reform to Medicaid," said Rep. Chip Roy (R-Texas).

Between the lines: The dynamic puts Johnson between a rock and a hard place as he tries to cobble together the roughly 218 votes he needs to pass the massive package.

• President Trump and Republicans are desperate to secure roughly $4 trillion in tax cuts, which they hope will stimulate the economy and boost their sagging poll numbers.
• The measure would also raise the debt ceiling, a key priority for Trump in order to deny Democrats potential political leverage.

State of play: House Energy and Commerce Chairperson Brett Guthrie (R-Ky.) told Axios on Monday that the GOP is looking at ways to reduce the federal contribution toward states' Medicaid expansions through the Affordable Care Act.

• "It takes away the open-ended checkbook," Guthrie said of one idea, the "per capita cap," which would place a limit on federal funding per enrollee in the Medicaid expansion.
• But the proposals would likely kick many lower-income enrollees off the Medicaid rolls, leading some moderates to oppose them.
• Rep. Mike Lawler (R-N.Y.), asked about another proposal, to lower the federal share of costs for the Medicaid expansion, replied: "I've been very clear about this. You guys keep asking the same stupid f--king question: No."
• Rep. Nick LaLota (R-N.Y.) said of the per capita cap: "My sense is that would be a cut, and I'm not in favor of that."

What's next: If the reconciliation bill passes the House, it could face an even tougher path in the Senate.

• Members like Sen. Josh Hawley (R-Mo.) have staked out a position that they oppose anything that would cut Medicaid benefits.

New House Energy and Commerce Chair Brett Guthrie (R-Ky.) has pushed for changes to Medicaid since his days as a state legislator. Now he's one of the main drivers behind what could become a sweeping overhaul of the safety net program.

Why it matters: Guthrie is pushing for spending limits that will be controversial as the House crafts a budget package. However, they could provide almost $900 billion to help extend the Trump 2017 tax cuts.

Catch up quick: He's pushing for "per capita caps," which would give states a fixed maximum amount of money for each person on Medicaid.

• The federal government now covers a percentage of states' Medicaid costs, so the amount reimbursed goes up or down depending on how much a state spends on the program.
• Per capita caps would likely result in less money for states, forcing them to make up the difference by raising taxes or cutting spending elsewhere.

What he's saying: Guthrie told Axios he saw how the Medicaid program affected state budgets firsthand while serving in the Kentucky Statehouse.

• "I dealt with it. That's why I care about this, I was on the budget committee in state government, and it just overwhelmed state budgets," he said.
• "What I've learned is as we keep subsidizing health care, the price keeps going up. So my idea with per capita allotments has always been that'll control costs."

He says per capita caps are the right way because they set a ceiling on federal spending but still allow for some flexibility because medical inflation can be accounted for.

• "It allows [the program] to grow at medical inflation," Guthrie said. "Every state gets the same money they get this year, plus medical inflation."

Still, he acknowledges the political difficulty of the situation, especially if it means people might fall off Medicaid.

• "I've talked to a lot of providers, other groups, and they're concerned," Guthrie said. "I'm not saying they're not, but I think we can do it in a way that people get service. The president's clearly said everybody's going to get their service they need in a way that's responsible to the budget."
• President Trump recently said he didn't want people's Medicaid benefits "affected," and instead wanted to target "abuse or waste" in the program.
• House Speaker Mike Johnson this week stated "Medicaid has never been on the chopping block."
• This is all amid House GOP moderates warning they could have issues with voting for deep cuts to Medicaid.

Flashback: Guthrie also pushed for per capita changes to Medicaid during the 2017 Affordable Care Act repeal debate.

• The House's repeal bill included a measure that would have set a cap on how much states received in funding based on their estimated number of beneficiaries, with adjustments for inflation.
• The late Sen. John McCain famously blocked that effort.

The bottom line: Even if Medicaid policy changes don't make it into this tax package due to political unfavorability, Guthrie isn't ready to give up.

• "I've always said that we need to reform Medicaid, even if it wasn't part of reconciliation, because the program is unsustainable," he said.
• "That's what we're working on. It depends on what we can get 218 votes for."

On top of the anticipated conservative opposition to House Speaker Mike Johnson's (R-La.) deal with Democrats to fund the government, consternation is emerging from unusual corners of Congress.

Why it matters: Provisions raising congressional pay and allowing members of Congress to opt out of the Affordable Care Act have some lawmakers sweating the potential political fallout.

• "They all want the [pay raise] and actual health insurance but don't want to vote for them," one House Republican told Axios.
• "There's some grumbling," said a senior House Democrat.

Driving the news: The spending bill would repeal language in a stopgap spending bill passed earlier this year that freezes an automatic cost-of-living adjustment (COLA) for members of Congress.

• It would be the first time since 2009 that members of Congress got a pay increase.
• It also includes language that would allow members to join the Federal Employee Health Benefits plan.

State of play: House Republicans' conservative wing is lining up against the bill, which they say is over-stuffed with legislative hobby horses. Some are singling out the pay raise in their condemnations.

• Some of that opposition has been driven by billionaire Elon Musk, a close confidante of President-elect Trump, publicly criticizing the bill.
• But it's not just the GOP's right flank, according to the House Republican who spoke on the condition of anonymity, who said there is some opposition "from every corner" and that the bill "is on thin ice."
• Swing-district Rep. Zach Nunn (R-Iowa) told Axios he is still considering the bill, but: "I have opposed stock trades, I have opposed benefits for members ... so this kind of falls in that whole category."

Zoom in: Rep. Jared Golden (D-Maine), one of the Democrats' most politically endangered members, said he will oppose the bill if the pay raise and ACA provisions are included.

• Rep. Marie Gluesenkamp Perez (D-Wash.), Golden's fellow co-chair of the centrist Blue Dog Coalition, called for leadership to "remove this [COLA] provision" in a statement shared with Axios.
• "It shouldn't be in there," said Rep. Jared Moskowitz (D-Fla.) – though he signaled he will vote for the bill because of disaster aid funding.
• Former House Majority Leader Steny Hoyer (D-Md.), a longtime champion of raising congressional pay, acknowledged that Democrats "are not happy in some instances."

By the numbers: The House is likely to vote on the bill under a process that requires a two-thirds majority – roughly 290 votes – to pass legislation.

• That means it would need virtually all House Democrats and around half of Republicans.
• Democratic leadership is supportive of the bill, with a Democratic leadership aide stressing in a statement to Axios that the ACA provision was the result of a "bipartisan negotiation."

What we're hearing: Democratic leadership is advising members on how to message their vote for the bill to counter public blowback to the provisions, according to multiple lawmakers familiar with the matter.

• House Minority Leader Hakeem Jeffries (D-N.Y.) "is being very clear that we need to point out, first of all, it's a Republican bill ... [and] it's complying with existing law rather than voting for an affirmative pay raise," said one senior House Democrat.
• Jeffries told Axios in a statement: "The legislation complies with existing law as set forth in the Ethics Reform Act of 1989."
• Rep. Alexandria Ocasio-Cortez (D-N.Y.) told Axios when asked about the provisions: "I mean, this is a Republican majority-run [bill], so these are what Republicans are putting on the floor."

The other side: The pay raise is "an unfair burden to many members and their families," said Rep. John Duarte (R-Calif.), who noted that he lost reelection and thus won't benefit from the pay raise.

• Several Democrats similarly argued that the COLA provision lowers the barrier of congressional service to those without independent wealth.
• Some also argued that the ACA provision puts them on even footing with the rest of the federal workforce, which isn't forced to use the ACA.
• One House Democrat told Axios: "It really doesn't sell that you believe in the program if you have to force people to be on it ... it's a bad look."